Saturday, November 6, 2010

Manipulating science

I picked up Devra Davis's The Secret History of the War on Cancer again, her sweeping indictment of the role politics has played in the science of epidemiology vis-a-vis health risks of smoking. The book is a great read, as it not only gives you the history of the fight, but also helps one understand the skepticism related to the methods we use to tie toxic exposures to adverse health outcomes.

One fascinating aspect of the story is the metastasis of public relations into the scientific discourse. On page 193, Davis quotes from Edward Bernays' 1928 book Propaganda:

"The conscious and intelligent manipulation of the organized habits and opinions of the masses is an important element of a Democratic society. Those who manipulate this unseen mechanism of society constitute an invisible government which is the true ruling power of our country.... We are governed, our minds are molded, our taste formed, our ideas suggested, largely by men we have never heard of. This is a logical result of the way in which our Democratic society is organized.... In almost every act of our daily lives, whether in this year of politics or business, in our social conduct or our ethical thinking, we are dominated by the relatively small number of persons... who understand the mental processes of the masses. It is they who pull the wires which control the public mind."

Note the split into the rulers and the sheep, the manipulation, the invisible governance, and again the manipulation. Sound familiar? For those of you not familiar with Bernays, he is generally considered to be the father of the public relations field. He was also the nephew of none other than Sigmund Freud, and, upon reading Freud's ruminations on the human psyche, adapted many of his ideas to manipulate consumers. In fact, it was Bernays who made it not only socially acceptable, but even desirable for women to smoke.

But I digress. What is the relevance of this quote from Bernays as used by Davis? Well, this was the strategy utilized to keep the mounting data on the dangers of tobacco from becoming credible. The popular tactic this strategy yielded was to have learned men with loud reputations refute the scientific basis of the reality of harm. Sound familiar?

I am not saying that the "learned men" of today are willfully obstructing the public from seeing the dirty underbelly of what medicine has become; I do not ascribe nefarious motives to them. However, given that we even have to ask the question "Should the public be told about the trouble with medical research?", it is an issue well worth discussing.

As you know, I am a great believer in transparency in both research and lay discourse. I believe that without a robust debate about topics that are far from clear, regardless of what the "learned men" will have us believe, we do harm to the society in several ways. First, lies damage relationships. Second, obfuscation creates distrust and sets up an adversarial atmosphere, which eventually leads to subversion of intentions, no matter how noble. Just look at the vaccine "debate" and how polarizing and destructive it is to both individual and public health. Third, it is manipulative and disrespectful, presuming lack of intellectual sophistication in our population. And while I am well aware that our literacy and numeracy are at an all time low, catering to the lowest common denominator is nothing but accepting and propagating the status quo. A better solution, though more time-consuming, is to start to fill these education gaps to improve our collective ability to engage in an edifying discussion.

To assert, as has been done here, that questioning any aspect of either the vaccine usefulness or the science of evolution for that matter equates to supporting the "anti-vaxers" or creationism, betrays a deep misunderstanding of how science is advanced. Indeed, it is by questioning certain aspects of science that do not seem to make sense that scientists both gain a better understanding of these ideas and at the same time demonstrate to the public how different our ways are from the entrenched dogma of organized religions.

I for one am proud of the process of science, and for this reason am working to bring what is under the hood out in the open. If we hide the messy uncertainties of our craft, we are doing a disservice to ourselves, our patients and the public at large. Worse yet, we are engaging in the manipulation, thus relegating scientific method to the wastebasket of PR and politics.

"To assert, as has been done here, that questioning any aspect of either the vaccine usefulness or the science of evolution for that matter equates to supporting the "anti-vaxers" or creationism, betrays a deep misunderstanding of how science is advanced. Indeed, it is by questioning certain aspects of science that do not seem to make sense that scientists both gain a better understanding of these ideas and at the same time demonstrate to the public how different our ways are from the entrenched dogma of organized religions."

Spare me. This is what I wrote:

"I realize that Dr. Zilberberg probably doesn't realize it, but this line of argument comes perilously close to Jenny McCarthy's beloved "too many too soon" slogan. Let me also say that I believe her when she says she is not anti-vaccine. Even so, she carelessly throws around rhetoric that, whether she realizes it or not, echoes a lot of anti-vaccine rhetoric. (And who is more of an expert on anti-vaccine rhetoric than I? Not many.) As Steve so aptly put it, what she's doing is akin to someone expressing skepticism towards some aspect of evolution and thereby appearing to support creationism because she didn't know the ways creationists distort and abuse science in the name of attacking evolution. She does the same thing here with vaccines. For example, elsewhere on her blog, as I mentioned before, Dr. Zilberberg referred to "rabid defenders of vaccines," while complaining about the lack of philosophical exemption laws in most states. Let's put it this way. If you don't want to be perceived as an anti-vaxer, don't refer to defenders of vaccines as "rabid" and don't start referring to the possibility of vaccine interactions in a way that is reminiscent of the arguments that anti-vaccine advocates make. I realize that Dr. Zilberberg's mistake is probably due to ignorance of the corrosiveness of the anti-vaccine movement, the depths of pseudoscience to which it regularly descends, and a lack of familiarity with their fallacious arguments, but hopefully this exchange will serve to educate her to be more careful in the future."

Once again, you do very much love the straw men arguments, don't you? My complaint was not that "questioning any aspect of either the vaccine usefulness or the science of evolution for that matter equates to supporting the "anti-vaxers" or creationism." There's the massive straw man. My complaint was that you in your ignorance of the anti-science tactics of the anti-vaccine movement led your "questioning" to sound an awful lot like some very common anti-vaccine canards.

Dear Orac, thanks for coming back. I am totally unclear on the utility of pointing out that my arguments "sound like" some "common anti-vaccine canards". I would find it a lot more helpful to understand why my arguments are flawed. Do we have some data somewhere that tells us that it is completely inconceivable that some environmental exposure over one's lifetime along with having had a vaccination as a kid cannot several decades down the road result in some adverse outcome? These are the multiple and potentially interacting exposures that I refer to, and they are notoriously difficult to study.It is entirely unhelpful to dismiss my argument out of hand because it sounds like someone else and then accuse me of building a straw man. Are you not in effect calling me anti-vaccine and anti-science when you say that I sound like that? Are we not engaging in equivocation?

Welcome and a disclaimer

Welcome to my blog, "Healthcare, etc."! In this blog I take the perspective of a researcher/policy wonk rather than an individual healthcare practitioner. Therefore, all opinions that I express and generalizations that I make about any issues will in no way be construed as medical advice for individual visitors / readers. All views expressed here are solely my own, and do not represent opinions of any organizations with which I am affiliated. I welcome all comments, but reserve the right not to publish paranoid or abusive rants or overt marketing pitches.

About Me

I am an independent physician health services researcher with a specific interest in healthcare-associated complications and a broad interest in the state of our healthcare system. I am also a professor of Epidemiology at the University of Massachusetts, Amherst.
I am frequently invited to speak about evidence-based medicine, methods and healthcare-associated complications.
My posts have been syndicated on The Health Care Blog, KevinMD,The Healthcare Collective and other sites. They have also been cited in the New York Times. Occasionally you can also find me blogging on the British Medical Journal blog site http://www.doc2doc.bmj.com
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